肝移植术前 2 型肝肾综合征与肝移植后持续肾功能受损相关。

Pretransplant Type 2 Hepatorenal Syndrome Is Associated With Persistently Impaired Renal Function After Liver Transplantation.

机构信息

1 Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 2 Liver Transplant Program, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

出版信息

Transplantation. 2015 Jul;99(7):1441-6. doi: 10.1097/TP.0000000000000557.

DOI:10.1097/TP.0000000000000557

PMID:25643142

Abstract

BACKGROUND

Type 2 hepatorenal syndrome (HRS2) is a functional renal impairment complicating end-stage liver disease. Although it is reversible after liver transplantation, long-term posttransplant outcomes in HRS2 patients remain ill-defined.

METHODS

Retrospective, matched case-control (1:2) study of all adult HRS2 patients transplanted in our institution between 2000 and 2012. The HRS2 patients were identified from our electronic transplant database, and matched with controls for the following variables: age, sex, etiology, diabetes mellitus, and year of transplant.

RESULTS

Forty-two HRS2 patients were compared to 83 controls. At the time of transplant, HRS2 patients had an estimated glomerular filtration rate of 41 ± 1 mL/min per 1.73 m. The HRS2 patients had greater intraoperative packed red blood cell transfusion (P = 0.002), and longer intensive care unit (P = 0.01) as well as total hospital length of stay (P = 0.03). Reversal of HRS2 occurred in 88.1% patients, 5.7 ± 0.5 days after transplantation. Although HRS2 patients had lower initial exposure to calcineurin inhibitors, a greater proportion of HRS2 patients had chronic kidney disease stage 3 (CKD3) at 3 (53.8% vs 28.4%; P = 0.007) and 12 months (59.5% vs 38.2%; P = 0.03) compared to controls. One-year survival was similar between the 2 groups (log-rank P = 0.82). On multivariate analysis, pretransplant HRS2 was associated with CKD3 at 3 (odds ratio, 3.73; 95% confidence interval, 1.54-9.03; P = 0.004) and 12 months (odds ratio, 3.23; 95% confidence interval, 1.37-7.64; P = 0.007) after transplantation.

CONCLUSIONS

Liver transplantation reverses HRS2 in the majority of patients with survival outcomes comparable to matched controls, despite longer stays in intensive care unit and in hospital. Pretransplant HRS2 is associated with early posttransplant CKD3, despite calcineurin-inhibitor minimization.

摘要

背景

2 型肝肾综合征（HRS2）是一种终末期肝病合并的肾功能损害。虽然它在肝移植后可以逆转，但 HRS2 患者的长期移植后结局仍不清楚。

方法

对 2000 年至 2012 年期间在我院接受移植的所有 HRS2 成年患者进行回顾性、匹配病例对照（1:2）研究。通过我们的电子移植数据库确定 HRS2 患者，并对以下变量与对照组进行匹配：年龄、性别、病因、糖尿病和移植年份。

结果

将 42 名 HRS2 患者与 83 名对照组进行比较。在移植时，HRS2 患者的估计肾小球滤过率为 41±1ml/min/1.73m2。HRS2 患者术中需要输注更多的浓缩红细胞（P=0.002），重症监护病房（P=0.01）和总住院时间（P=0.03）也更长。HRS2 逆转发生在 88.1%的患者中，在移植后 5.7±0.5 天。尽管 HRS2 患者初始接触钙调神经磷酸酶抑制剂的比例较低，但在 3 个月（53.8%比 28.4%；P=0.007）和 12 个月（59.5%比 38.2%；P=0.03）时，HRS2 患者发生慢性肾脏病 3 期（CKD3）的比例更高。两组患者 1 年生存率相似（对数秩检验 P=0.82）。多变量分析显示，移植前 HRS2 与移植后 3 个月（优势比，3.73；95%置信区间，1.54-9.03；P=0.004）和 12 个月（优势比，3.23；95%置信区间，1.37-7.64；P=0.007）时的 CKD3 相关。